肝细胞癌切除术后复发的临床预测模型的建立及其预测价值

Establishment and predictive value of clinical prediction model for the recurrence after resection of hepatocellular carcinoma

目的构建肝细胞癌(肝癌)术后复发的临床预测模型,并探讨其预测价值。方法本前瞻性研究对象为2007年1月至2013年12月在中山大学附属第三医院行肝切除术的195例肝癌患者。其中男172例,女23例;年龄13~81岁,中位年龄49岁。患者均签署知情同意书,符合医学伦理学规定。患者术后接受随访,记录肿瘤复发情况,采用Cox比例风险回归模型筛选影响肝癌术后肿瘤复发的临床参数;根据临床参数建立肝癌术后复发的临床预测模型。采用受试者工作特征(ROC)评估其预测价值。结果患者术后总复发率为44.1%,1、2、3年的复发率分别为30.7%、38.9%、44.1%。ALT>41.5 U/L、指捏法、肝硬化、肿瘤直径≥4.35 cm、肿瘤数目≥3个、门静脉癌栓、低分化均为肝癌术后复发的独立危险因素(HR=1.687,-,2.078,1.759,-,3.879,-;P<0.05)。临床预测模型:个体预后指数(PI)=0.52×ALT-0.9×手术器械(1)-0.442×手术器械(2)+0.7×肝硬化+0.56×肿瘤直径-1.21×肿瘤数目(1)-1.029×肿瘤数目(2)+1.35×门静脉侵犯-0.6×分化(1)-0.853×分化(2)。PI值越大,复发风险越高。ROC曲线下面积为0.74,预测复发特异度为85.3%,敏感度为52.3%。结论 ALT>41.5 U/L、指捏法、肝硬化、肿瘤直径≥4.35 cm、肿瘤数目≥3个、门静脉癌栓、低分化是肝癌术后复发的独立危险因素。本研究所构建的复发预测模型预测效果良好,对肝癌术后肿瘤复发的预测具有重要意义。

Objective To establish a clinical prediction model for the recurrence a^ler resection ot hepatocellular carcinoma （HCC） and investigate its predictive value. Methods One hundred and ninety-five patients with HCC who underwent hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University from January 2007 to December 2013 were enrolled in this prospective study. Among them, 172 were males and 23 females, aged 13-81 years old with a median age of 49 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The＇patients were followed up after surgery, and the tumor recurrence was recorded. Clinical parameters of tumor recurrence after resection of HCC were screened by Cox＇s proportional hazards regression model. Clinical prediction model for the recurrence after resection of HCC was established based upon the clinical parameters. The predictive value of this model was assessed by receiver operating characteristic （ROC）. Results The postoperative overall recurrence rate was 44.1%. The 1-, 2-, 3- year recurrence rate was respectively 30.7%, 38.9% and 44.1%. ALT〉41.5 U/L, Pringle＇s maneuver, liver cirrhosis, tumor diameter ≥ 4.35 cm, tumor number ≥ 3, portal vein tumor thrombus and low differentiation were the independent risk factors of recurrence after resection of HCC （HR=1.687, -, 2.078, 1.759, -, 3.879, -; P〈0.05）. Clinical prediction model： personal prognosis index （PI）= 0.52xALT-0.9xsurgical instrument （1）-0.442xsurgical insmtment （2）＋0.7× liver cirrhosis＋0.56× tumor diameter -1.21×tumor number （1）-l.029×tumor number （2）＋l.35× portal vein invasion-0.6× differentiation （1）-0.853×differentiation （2）. The risk of recurrence was higher as the value of PI increased. The area under ROC curve was 0.74, the specificity for predicting recurrence was 85.3% and the sensitivity was 52.3%. Conclusions ALT〉41.5 U/L, Pringle＇s maneuver, liver cirrhosis, tumor diameter ≥ 4.35 cm, tumor number ≥ 3, portal vein tumor thrombus and low differentiation are the independent risk factors of recurrence after resection of HCC. The recurrence prediction model established in this study yields good predictive effects, and has important significance for predicting the recurrence after resection of HCC.